Effect of percutaneous transluminal angioplasty prior to arteriovenous fistula creation for small-diameter artery in hemodialysis patients

doi:10.3877/cma.j.issn.2095-3216.2024.05.002

Abstract

Abstract:

Objective

The study aimed to investigate the efficacy of percutaneous transluminal angioplasty （PTA） prior to arteriovenous fistula （AVF） creation for small-diameter artery in hemodialysis patients.

Methods

This study was a single-center prospective cohort study. A total of 108 patients with end-stage renal disease （ESRD） to establish long-term hemodialysis access，whose forearm small artery（radius or ulnar artery） was ＜1. 5 mm in diameter，were enrolled from the Department of Nephrology，Cancer Hospital Affiliated to Guizhou Medical University from June 1，2021 to June 1，2023. Among them，76 patients underwent AVF creation after PTA （PTA+AVF group），while 32 patients underwent only AVF creation as control （AVF group）. All the patients' general information，relevant data during and after PTA，and diameters and blood flow indicators of brachial artery，ulnar artery，radial artery，cephalic vein，and basilic vein，as well fistula maturation indicators after AVF creation. The differences between the two groups were then statistically analyzed.

Results

The radial/ulnar artery diameter and the peak systolic velocity（PSV） immediately after PTA in the PTA+AVF group were higher than those before PTA （t= -10.644，P ＜0.01； t= -6.386，P ＜0.001）. The radial/ulnar artery diameter and PSV at 1 day after PTA were also higher than those before PTA （t= -10.645，P ＜0.01； t= -6.388，P ＜0.00）. However，there were no significant differences between the radial/ulnar artery diameter and PSV immediately after PTA and those at 1 day after PTA （t= -0.129，P =0.897； t =0.571，P =0.569）. At 4，8，and 12 weeks after AVF creation，the blood flow volume of brachial artery and diameters of cephalic/basilic vein and radial/ulnar artery of the PTA+AVF group were all higher than those of the AVF group （P ＜0.05）. And at 4，8，and 12 weeks after AVF，the fistula maturation rates of the PTA +AVF group were 22.97% （17/74 cases），81.08% （60/74 cases），and 93.24% （69/74 cases），respectively，while those in the AVF group were 6.25% （2/32 cases），33.33% （9/27 cases），and 42.31% （11/26 cases），respectively. In the PTA+AVF group，the fistula maturation rates at 4，8，and 12 weeks after AVF were higher than those in the AVF group （χ² =4.247，P ＜0.05； χ² =20.836，P ＜0.001； χ² =31.198，P ＜0.001）.

Conclusion

A good AVF maturation rate could be obtained by AVF creation after PTA for the small-diameter arteries of the hemodialysis patients，which may be one of the strategies to effectively utilize the resources of small-diameter arteries of the patients' forearms.

Key words: Hemodialysis, Small-diameter artery, Percutaneous transluminal angioplasty, Arteriovenous fistula creation

Chaojiang Su, Jiali Liu, Yan Jiang, Ting Xu, Liting Liu, Yan Chen, Zongyang Liu. Effect of percutaneous transluminal angioplasty prior to arteriovenous fistula creation for small-diameter artery in hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(05): 249-255.

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URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2024.05.002

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References 27

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变量	PTA+AVF组（76例）	AVF组（32例）	统计量	P值
年龄（岁）	41.88±8.92	42.33±9.66	t=-0.360	0.720
男性[例（%）]	26（34.21）	12（37.5）	χ ²=0.107	0.744
吸烟[例（%）]	19（25）	10（31.25）	χ ²=0.448	0.503
原发病[例（%）]			χ ²=4.944	0.085
糖尿病	26（34.21）	13（40.6）
慢性肾炎	25（32.89）	15（46.88）
其他	25（32.89）	4（12.5）
静脉直径（mm）	2.62±0.23	2.63±0.31	t=-0.615	0.538
桡/尺动脉
动脉直径（mm）	1.33±0.09	1.35±0.1	t=0.176	0.860
动脉收缩期峰值（cm/s）	27.79±8.34	29.13±7.45	t=0.969	0.069

变量	PTA+AVF组（76例）	AVF组（32例）	统计量	P值
年龄（岁）	41.88±8.92	42.33±9.66	t=-0.360	0.720
男性[例（%）]	26（34.21）	12（37.5）	χ ²=0.107	0.744
吸烟[例（%）]	19（25）	10（31.25）	χ ²=0.448	0.503
原发病[例（%）]			χ ²=4.944	0.085
糖尿病	26（34.21）	13（40.6）
慢性肾炎	25（32.89）	15（46.88）
其他	25（32.89）	4（12.5）
静脉直径（mm）	2.62±0.23	2.63±0.31	t=-0.615	0.538
桡/尺动脉
动脉直径（mm）	1.33±0.09	1.35±0.1	t=0.176	0.860
动脉收缩期峰值（cm/s）	27.79±8.34	29.13±7.45	t=0.969	0.069

变量	PTA术前（76例）	PTA术后即刻（76例）	PTA术后1d（72例）
桡/尺动脉直径（mm）	1.33±0.09	2.34±0.24^a	2.37±0.21^b
前臂动脉收缩期峰值血流速度（cm/s）	27.79±8.34	45.84±8.31^c	46.04±7.17^c

变量	PTA术前（76例）	PTA术后即刻（76例）	PTA术后1d（72例）
桡/尺动脉直径（mm）	1.33±0.09	2.34±0.24^a	2.37±0.21^b
前臂动脉收缩期峰值血流速度（cm/s）	27.79±8.34	45.84±8.31^c	46.04±7.17^c

组别	肱动脉血流量
组别	AVF成形术术后1d	AVF成形术术后4周	AVF成形术术后8周	AVF成形术术后12周
AVF组	186.34±50.90	410.01±85.10	434.97±143.30	456.80±103.22
PTA+AVF组	213.93±40.07	473.27±100.39	615.19±108.79	807.86±130.27
t值	2.858	-2.056	2.142	4.317
P值	＜0.001	0.031	＜0.001	＜0.001

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